Miss L was taken to hospital via ambulance following a road traffic collision. During her initial triage assessment she complained of pain to her right arm, sternum and back. A CT scan was requested revealing right rib fractures, lung contusion and shallow haemopneumothorax (air in the chest cavity). There is no reference to a broken clavicle (collarbone) on the CT report.
The following day the CT scan was reviewed again and an issue with the right clavicle was noted. Miss L was referred for orthopaedic review. The orthopaedic Specialist Registrar (SPR) reviewed Miss L and the previous CT scan and diagnosed an undisplaced right clavicle fracture. A further x-ray in a week’s time was requested for reassessment. There is no evidence in the records or radiology that the repeat x-ray was performed.
The following day, morphine was administered due to extensive pain and the records indicate that a collar and cuff sling was provided to support her right arm. The sling broke within a matter of hours and no further sling was provided. A further orthopaedic review was conducted. This outlined that Miss L was tender at the clavicle and suspected ACJ disruption (separation of the collar bone from the shoulder blade). There was consideration given to requesting a further x-ray of the clavicle but again, there is no evidence that this materialised.
A consultant orthopaedic surgeon reviewed Miss L a week after her admission. The consultant noted non operative management and advised use of a poly sling for comfort. A follow-up appointment was requested for a week later with x-rays on arrival. Miss L was discharged from hospital without a sling or any aids or equipment.
Miss L was seen in the outpatient clinic. The clinical letter from this appointment describes a displaced fracture to the right clavicle with rupture of the CC ligaments and superior capsular ligaments. Prior to this typed correspondence the fracture was always recorded as undisplaced. There is no evidence in the records or radiological studies that x-rays were performed on arrival.
Miss L was reviewed again twice. X-rays were taken at each consultation. She was advised that the clavicle was reuniting in a mal united position but considered surgical intervention too risky.
Miss L continues to suffer with a deformed shoulder as a result of a 100% displaced clavicle fracture and widely separated AC joint (the joint at the top of the shoulder). She suffers extensive pain preventing her from using her right arm.
It was alleged that had the injury been treated initially she would have undergone fixation of the clavicle, reconstruction of the CC ligament and reconstruction of the AC joint. Miss L would likely have been in a sling for 3 months and off work for 6 months, limited to work of a light manual nature for a further six months and unrestricted after this. It would be reasonable to expect some minor stiffness and weakness in the shoulder but without functional limitation.
As a result of the failure to treat the right shoulder injury Miss L has experienced severe unremitting pain and dysfunction.
Miss L’s case reached settlement following negotiation.